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Soares I, Amaral IP, Correia MP, Travassos R, Filipe P. Complications of dermatologic lasers in high Fitzpatrick phototypes and management: an updated narrative review. Lasers Med Sci 2024; 39:149. [PMID: 38834924 DOI: 10.1007/s10103-024-04100-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
This article explores the intricacies of laser surgery, acknowledging inherent risks and complications. Patients with higher Fitzpatrick phototypes, characterized by unique biological traits, face heightened vulnerability during laser treatments. Limited experience with darker skin tones necessitates a higher level of laser expertise and a conservative approach. The study aims to comprehensively review laser therapy's side effects and complications, with a specific focus on Fitzpatrick phototypes IV through VI. We searched the MEDLINE database from 1972 to 2023 to consolidate knowledge. Results illuminate nuanced challenges associated with laser surgery in higher phototypes. In conclusion, this research emphasizes the need for enhanced expertise and caution in laser procedures for individuals with darker skin, offering valuable insights to optimize patient safety and outcomes.
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Affiliation(s)
- Ivânia Soares
- Departament of Dermatology, Hospital de Santa Maria, Lisbon, Portugal.
| | | | | | - Rita Travassos
- Departament of Dermatology, Hospital de Santa Maria, Lisbon, Portugal
- Universidade de Lisboa Faculdade de Medicina, Dermatology University Clinic, Lisbon, Portugal
| | - Paulo Filipe
- Departament of Dermatology, Hospital de Santa Maria, Lisbon, Portugal
- Universidade de Lisboa Faculdade de Medicina, Dermatology University Clinic, Lisbon, Portugal
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Lupon E, Berkane Y, Bertheuil N, Cetrulo CL, Vaillant C, Chaput B, Camuzard O, Lellouch AG. Nonsurgical Treatment of Postburn Hypopigmentation: A Literature Review. J Burn Care Res 2024; 45:601-607. [PMID: 38401148 DOI: 10.1093/jbcr/irae030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Indexed: 02/26/2024]
Abstract
The treatment of postburn hypopigmentation was primarily surgical before the advent of new technologies. Medical devices and therapies are emerging to manage scar sequelae that can be disfiguring and associated with severe psychosocial impact. These innovations have been poorly investigated for hypopigmentation, but they represent a real hope. We reviewed all articles published on Pubmed up to June 2022. Included studies had to specifically focus on treating postburn hypopigmented scars. All articles evaluating transient solutions such as make-up, and articles describing inflammation-linked hypopigmentation with no etiological details or no burn injury history were excluded. Through this review, we have highlighted 6 different types of nonsurgical treatments reported in postburn leukoderma potentially allowing definitive results. Electrophoto-biomodulation or E light (combining intensive pulsed light, radiofrequency, and cooling), topical daylight psoralen UVA therapy, and lasers (fractional lasers using pulse energies or CO2FL devices, lasers-assisted drug delivery as local bimatoprost and tretinoin or pimecrolimus) have been explored with encouraging results in hypopigmented burns. Finally, other promising medical strategies include using FK506, a nonsteroidal anti-inflammatory drug, to induce melanogenesis or using melanocyte-stimulating hormones with fractional laser-assisted drug deliveries, which are expected to emerge soon.
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Affiliation(s)
- Elise Lupon
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur et du Sport, Pasteur 2 Hospital, University Côte d'Azur, 06001 Nice, France
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, 02114 Boston, MA, USA
| | - Yanis Berkane
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, 02114 Boston, MA, USA
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 35000 Rennes, France
| | - Nicolas Bertheuil
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 35000 Rennes, France
| | - Curtis L Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, 02114 Boston, MA, USA
- Department of Plastic Surgery, Massachusetts General Hospital, 02114 Boston, MA, USA
| | - Camille Vaillant
- Department of Plastic, Reconstructive and Aesthetic Surgery, Hospital Sud, University of Rennes 1, 35000 Rennes, France
| | - Benoît Chaput
- Department of Plastic Surgery, University Toulouse III Paul Sabatier, 31000 Toulouse, France
| | - Olivier Camuzard
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur et du Sport, Pasteur 2 Hospital, University Côte d'Azur, 06001 Nice, France
| | - Alexandre G Lellouch
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, 02114 Boston, MA, USA
- Department of Plastic Surgery, Massachusetts General Hospital, 02114 Boston, MA, USA
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Mallat F, Chaaya C, Aoun M, Soutou B, Helou J. Adverse Events of Light-Assisted Hair Removal: An Updated Review. J Cutan Med Surg 2023; 27:375-387. [PMID: 37272371 DOI: 10.1177/12034754231174852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND With light-assisted hair removal becoming widely used, reports of adverse effects are increasing. OBJECTIVE To review all the reported optical incidents and cutaneous complications of laser or intense pulse light-assisted hair removal. METHODS A PubMed database systematic search was performed to identify studies reporting such adverse events before July 2022 using the Mesh terms "adverse effects" AND "hair removal" AND ("laser" OR "intense pulse light"). RESULTS Altogether, 358 references were identified. After excluding duplicates, unrelated articles, guidelines, and conference abstracts, then adding references from studies bibliography, 104 publications were included. Ocular incidents consisted of anterior uveitis, iritis and iris atrophy, pupillary distortion, posterior synechiae, anterior chamber pigment, and cataracts in the anterior subcapsular region. Cutaneous complications consisted of pain, burns, folliculitis, leukotrichia, paradoxical hypertrichosis, pigmentary changes, changes in nevi, pili bigemini, herpes infection, hyperhidrosis, bromhidrosis, Fox-Fordyce disease, and frostbite from the cooling system. They were mostly correlated to skin type and body area as well as to light device and set parameters. Intense pulse light devices were found to be less painful than alexandrite laser, yet more painful than diode laser; Nd:YAG laser had the highest pain score. CONCLUSION Optical incidents can be systematically avoided. Cutaneous complications are usually related to professional errors and patient characteristics. Better knowledge of laser physics and adequate training of laser operators are key recommendations to avoid undesirable side effects. Safety recommendations help prevent most of the reported complications.
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Affiliation(s)
- Farid Mallat
- Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
| | - Céline Chaaya
- Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
| | - Maroun Aoun
- Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
| | - Boutros Soutou
- Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
- Dermatology Department, Hôtel-Dieu de France, Beirut, Lebanon
| | - Josiane Helou
- Faculté de Médecine, Université Saint-Joseph, Beirut, Lebanon
- Dermatology Department, Hôtel-Dieu de France, Beirut, Lebanon
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Facial Rejuvenation in Patients of Color. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00407-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Bhat YJ, Bashir S, Nabi N, Hassan I. Laser Treatment in Hirsutism: An Update. Dermatol Pract Concept 2020; 10:e2020048. [PMID: 32363110 DOI: 10.5826/dpc.1002a48] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2019] [Indexed: 10/31/2022] Open
Abstract
Unwanted hair growth, which is a common aesthetic problem, has traditionally been treated using various techniques such as shaving, waxing, and epilation, but most of these provide only a temporary solution. Laser and light-based technology for hair removal has become one of the fastest growing procedures in modern cosmetic dermatology in the last decade. Clinical experience suggests that in the ideal subject with fair skin and dark hair, laser treatment can reduce hair growth significantly. This article reviews the various laser and light-based devices used for hair removal along with the various laser and patient parameters that affect the outcome of laser treatment for hair removal. Photoepilation, when properly used, offers clear advantages when compared with older, traditional techniques.
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Affiliation(s)
- Yasmeen Jabeen Bhat
- Department of Dermatology, STD & Leprosy, Government Medical College, Srinagar, India
| | - Safia Bashir
- Department of Dermatology, STD & Leprosy, Government Medical College, Srinagar, India
| | - Nahida Nabi
- Department of Dermatology, STD & Leprosy, Government Medical College, Srinagar, India
| | - Iffat Hassan
- Department of Dermatology, STD & Leprosy, Government Medical College, Srinagar, India
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Laser and Light Treatments for Hair Reduction in Fitzpatrick Skin Types IV-VI: A Comprehensive Review of the Literature. Am J Clin Dermatol 2018; 19:237-252. [PMID: 28791605 DOI: 10.1007/s40257-017-0316-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Unwanted facial and body hair presents as a common finding in many patients, such as females with hirsutism. With advances in laser and light technology, a clinically significant reduction in hair can be achieved in patients with light skin. However, in patients with darker skin, Fitzpatrick skin types (FST) IV-VI, the higher melanin content of the skin interferes with the proposed mechanism of laser-induced selective photothermolysis, which is to target the melanin in the hair follicle to cause permanent destruction of hair bulge stem cells. Many prospective and retrospective studies have been conducted with laser and light hair-removal devices, but most exclude patients with darkly pigmented skin, considering them a high-risk group for unwanted side effects, including pigmentation changes, blisters, and crust formation. We reviewed the published literature to obtain studies that focused on hair reduction for darker skin types. The existing literature for this patient population identifies longer wavelengths as a key element of the treatment protocol and indicates neodymium-doped yttrium aluminum garnet (Nd:YAG), diode, alexandrite, and ruby lasers as well as certain intense pulsed light sources for safe hair reduction with minimal side effects in patients with FST IV-VI, so long as energy settings and wavelengths are appropriate. Based on the findings in this review, safe and effective hair reduction for patients with FST IV-VI is achievable under proper treatment protocols and energy settings.
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Casanova D, Alliez A, Baptista C, Gonelli D, Lemdjadi Z, Bohbot S. A 1-Year Follow-Up of Post-operative Scars After the Use of a 1210-nm Laser-Assisted Skin Healing (LASH) Technology: A Randomized Controlled Trial. Aesthetic Plast Surg 2017; 41:938-948. [PMID: 28233128 DOI: 10.1007/s00266-017-0820-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/06/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laser therapies are used prophylactically for excessive scar formation. The Laser-Assisted Skin Healing treatment induces a controlled heat stress that promotes tissue regeneration. This comparative trial is the first to evaluate the performance of a new automated 1210-nm laser system, compatible with all Fitzpatrick scale phototypes. METHODS Forty women undergoing bilateral breast reduction were enrolled in this double-blinded randomized controlled trial. The horizontal sutured incision of one breast was treated with the portable 1210-nm laser while in the operating theatre. The other breast was used as the study control. Objective measurements, subjective clinical assessments and safety evaluation were carried out over 1 year by both clinicians and patients. RESULTS Six weeks following surgery, better overall appearance and modified OSAS scores were reported for the laser-treated scars when compared to the control group (p = 0.024 and p = 0.079). This supports an early effect of the laser treatment during the inflammatory stage of the healing process. After a post-treatment period of 6 months, there continued to be a strong tendency in favour of the laser treatment based on the subjective scores and corroborated by the objective improvement of the treated scar volume (p = 0.038). At 1 year, the laser-treated scars continued to improve compared to the control ones in terms of volume (p = 0.004), surface (p = 0.017) and roughness (p = 0.002), and these comparatively better results were strengthened with the blind expression of patients' preference for their laser-treated scar (p = 0.025). CONCLUSIONS This new 1210-nm laser treatment, used as a single session performed immediately after surgery, provides significant objective and subjective improvements in scar appearance. These data can be useful when preparing patients to undergo their surgical procedure. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Fadul-Elahi T, Janjua NB. Laser-induced synlabia, cryptomenorrhea, and urine retention: A case report and literature review. Urol Ann 2017; 9:380-383. [PMID: 29118543 PMCID: PMC5656966 DOI: 10.4103/ua.ua_7_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Cosmetic laser use has many pros and cons. The worldwide use of laser for body hair removal has led to many medical complications. Unsupervised use of the laser for hair removal in vulva may result in many problems and can merely damage the vulva, although rarely, affecting the body image. This rare and novel case report is a 21 year old virgin who presented with acute urinary retention and cryptomenorrhea due to complete synlabia secondary to unsupervised vulval laser hair removal. The urinary retention was relieved by suprapubic catheterization initially. During examination under anesthesia, the fused labia were separated by a surgical incision with drainage of hematocolpos and then, a Foley's urethral catheter was inserted. She had an uneventful recovery. We report this case to emphasize on the supervised use of laser by trained and qualified personnel for hair removal in vulva to minimize its complications.
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Affiliation(s)
- Thoraya Fadul-Elahi
- Department of Obstetrics and Gynecology, Ohud Hospital, Madinah, Saudi Arabia
| | - Nusrat Batool Janjua
- Department of Obstetrics and Gynaecology, Letterkenny University Hospital, Co Donegal, Ireland
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Horiguchi M, Miyata N, Mizuno H. A preclinical study testing "Focused multiple laser beams," a new concept of irradiation with the 1064-nm Nd:YAG laser for skin rejuvenation. J COSMET LASER THER 2016; 19:76-82. [PMID: 27834498 DOI: 10.1080/14764172.2016.1256484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In order to avoid epidermal heat damage, we developed a novel irradiation method termed "Focused multiple laser beams (FMLB)," which allows long-pulse neodymium:yttrium aluminum garnet (Nd:YAG) laser beams to be irradiated from several directions in a concentric fashion followed by focusing into the dermis without epidermal damage. This study aimed to assess whether FMLB achieves the desired dermal improvement without epidermal damage. MATERIALS AND METHODS The dorsal skin of New Zealand White rabbits was irradiated with FMLB. Macroscopic and histological analyses were performed after 1 hour and 1, 2, 3 and 4 weeks. Real-time PCR analysis of type I and III collagen expression was performed at two and four weeks. RESULTS Control groups exhibited skin ulcers which were healed with scar formation whereas FMLB groups remained intact macroscopically. Histologically, FMLB group showed increase in dermal thickness at four weeks while the epidermis remained intact. Real-time PCR demonstrated that both type I and III collagen increased at two weeks but decreased at four weeks. CONCLUSIONS FMLB can deliver the target laser energy to the dermis without significantly affecting the epidermis.
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Affiliation(s)
- Masatoshi Horiguchi
- a Department of Plastic and Reconstructive Surgery , Juntendo University School of Medicine , Tokyo , Japan
| | | | - Hiroshi Mizuno
- a Department of Plastic and Reconstructive Surgery , Juntendo University School of Medicine , Tokyo , Japan
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